HomeMy WebLinkAboutBERNA ROOFING - INSURANCE CERTIFICATECERTIFICATE OF LIABILITY INSURANCE
American Family Insurance Company ❑
American Family Mutual Insurance Company if selection box is not checked.
6000 American Pky Madison, Wisconsin 537B3-0001
Agent's Name, Address and Phone Number (Agt./Dist.)
Dan Richmond Agency
923 E Prospect Road
Fort Collins, CO 80525
970 484-2881
Insured's Name and Address:
(125/309) Bernardo Caceres
dba Berne Roofing
1200 E Stuart #75
Fort Collins CO 80525
This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder.
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This is to certify that policies of insurance listed below have been issued to the insured named above for the policy period indicated, notwithstanding any
requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded
by the policies described herein is subject to all the terms, exclusions, and conditions of such policies.
POLICY TYPE
TYPE OF INSURANCE
POLICY NUMBER
LIMITS OF LIABILITY
Effective
Expiration
Mo,Da ,Yr
Mo,Da ,Yr
Homeowners/
Bodily Injury and Property Damage
Mobilehomeowners Liability
Each Occurrence
Boatowners Liability
Bodily Injury and Property Damage
Each Occurrence
Personal Umbrella Liability
Bodily Injury and Property Damage
Each Occurrence
Form/Ranch Liability
Farm & Personal Liability Each Occurrence
Farm Employer's Liability Each Occurrence
Statutory
Workers Compensation and
Each Accident
Employers Liability+
Disease - Each Employee
Disease - Policy Limit
General Liability
General Aggregate $ 600,000
® Commercial General
05XD7390
9/3/2004
9/3/2004
Products - Completed Operations Aggregate $ 600,000
Liability (occurrence)
Personal and Advertising Injury $ 300,000
❑
Each Occurrence $ 300,000
❑
Damage to Premises Rented to You $ 100,000
Medical Expense (Any One Person $ 5,000
Businessowners Liability
Each Occurrence ++
Aggregate + +
Liquor Liability
Common Cause Limit
Aggregate Limit
Automobile Liability
Bodily Injury - Each Person
❑ Any Auto
Bodily Injury - Each Accident
❑ All Owned Autos
Property Damage
❑ Scheduled Autos
Bodily Injury & Property Damage Combined
❑ Hired Autos
❑ Nonowned Autos
Excess Liability
❑ Commercial Blanket Excess
Each Occurrence/Aggregate
Other (Miscellaneous Coverages)
DESCRIPTION OF OPERATIONS/LOCATIONStVEHICLES/RESTRICTIONS/SPECIAL ITEMS
+ The individual or partners shown as Insured •** elected to be
ROOFING
covered as employees under this policy.
++ Products -Completed Operations aggregate is equal to each
occurrence limit and is included in policy aggregate.
CERTiFICATEHOLAER'S. 6'i�NA-l1Rtf7R
SS-;,";
,'i:.CANCEtt.At1ON ,
® Should any of the above described policies be canceled before the
City of Fort Collins
Y
expiration date thereof, the company will endeavor to mail '(10 days) written
P.O. Box 580
notice to the Certificate Holder named, but failure to mail such notice shall
Fort Collins CO 80522
impose no obligation or liability of any kind upon the company, its agents or
representatives. *10 days unless different number of days shown.
❑ This certifies coverage on the date of issue only. The above described
policies are subject to cancellation in conformity with their terms and by the
laws of the state of issue.
DATE ISSUED
AUTHORIZED
09/03/2004
/REPRESENTATIVE
U-201 Ed. 05/00 ORIGINAL - Certificate holder, COPIES to Services, Insures, Agent OLx K rvU. 00000